Healthcare Provider Details

I. General information

NPI: 1790566834
Provider Name (Legal Business Name): MILWAUKEES LEARNING ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5423 W VLIET ST STE 108
MILWAUKEE WI
53208-2180
US

IV. Provider business mailing address

5423 W VLIET ST STE 108
MILWAUKEE WI
53208-2180
US

V. Phone/Fax

Practice location:
  • Phone: 414-349-0619
  • Fax:
Mailing address:
  • Phone: 414-349-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: LEAH WHATLEY
Title or Position: BUSINESS OWNER
Credential:
Phone: 414-349-0619